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vii
Preface xxi
CHAPTER 1Anatomy, Neuroanatomy, and Physiology of the Speech Mechanism xxiv
Respiration: Structures and Processes 1
Respiration Patterns During Speech Production 1
Framework of Respiration 2
Muscles of Respiration 6
Phonation: Structures and Processes 8
The Larynx 8
Laryngeal Structures and Cartilages 9
Intrinsic Laryngeal Muscles 11
Extrinsic Laryngeal Muscles 12
Vocal Folds 13
Physiology of Phonation 14
Neuroanatomy of the Vocal Mechanism 16
Resonation and Articulation: Structures and Processes 17
Fundamentals of Resonation 17
Fundamentals of Articulation 18
Neuroanatomy and Neurophysiology: The Nervous System 30
Neurons and Neural Transmission 30
Anatomy and Physiology of Nerve Cells 30
Neural Transmission 31
The Peripheral and Autonomic Nervous Systems 33
Peripheral Nervous System 33
Autonomic Nervous System 43
The Central Nervous System 44
Basic Principles 44
The Brainstem 44
Reticular Activating System 48
Diencephalon 49
Basal Ganglia 49
The Cerebellum 50
The Cerebrum 51
Pyramidal System 56
Corticobulbar Tract 57
Extrapyramidal System 57
Connecting Fibers in the Brain 60
The Cerebral Ventricles 61
viii Contents
Protective Layers of the Brain 62
Cerebral Blood Supply 62
Chapter Highlights 67
Study and Review Questions 68
Study and Review Answers 70
CHAPTER 2Physiological and Acoustic Phonetics: A Speech Science Foundation 72
Basic Principles and Definitions 73
Definitions 73
Phonetic Transcription 75
The International Phonetic Alphabet 75
Broad Phonetic Transcription 75
Narrow Phonetic Transcription 75
Production of Segmentals: Consonants and Vowels 77
Consonants and Vowels: The Syllable as a Unit 77
Classification Systems 78
Consonants 80
Vowels 84
The Effects of Context on Speech Sound Production 88
Dynamics of Speech Production 88
Suprasegmentals 88
Speech Science: Physiological Phonetics, Acoustic Phonetics, and Speech
Perception 90
Acoustics: Basic Definitions 90
Introduction to the Study of Sound and Acoustic Analysis of Speech 92
Sound Wave Generation and Propagation 92
Frequency and Pitch 93
Amplitude and Loudness 94
Sound Pressure Level and Hearing Level 94
Introduction to the Acoustic Analysis of Speech 95
Chapter Highlights 96
Study and Review Questions 97
Study and Review Answers 100
Contents ix
CHAPTER 3Language Development in Children 102
Terms and Definitions 103
Morphology 103
Syntax 105
Semantics 106
Pragmatics 108
Typical Language Development: Developmental Milestones 109
Role of the Caregiver in Language Development 109
Birth–1 Year 110
1–2 Years 112
2–3 Years 114
3–4 Years 117
4–5 Years 119
5–6 Years 120
6–7 Years 122
7–8 Years 123
Language and Literacy Development in the School-Age Years 124
Theories of Language Development 125
Behavioral Theory 125
Nativist Theory 126
Cognitive Theory 127
Information- Processing Theory 128
Social Interactionism Theory 131
Chapter Highlights 133
Study and Review Questions 134
Study and Review Answers 140
CHAPTER 4Language Disorders in Children 142
Introduction to Children With Language Disorders 143
Description of Language Disorders in Children 144
Risk Factors for Language Disorders in Children 144
Children With Specific Language Impairment 145
Characteristics of Children With Specific Language Impairment 145
x Contents
Children With Language Problems Associated
With Physical and Sensory Disabilities 149
Intellectual Disability 149
Autism Spectrum Disorder 151
Brain Injury 153
Children With Language Problems Related
to Physical and Social– Environmental Factors 156
Language Problems Related to Poverty 156
Language Problems Related to Neglect or Abuse 158
Language Problems Related to Parental Drug and Alcohol Abuse 159
Language Problems Related to Attention- Deficit/Hyperactivity Disorder 160
Assessment Principles and Procedures 162
Language Assessment: General Principles and Procedures 162
Assessment of Infants and Toddlers 166
Assessment of Preschool and Elementary-Age Children 169
Assessment of Adolescents 171
Treatment Principles and Procedures 174
General Principles 174
Specific Techniques and Programs 176
Augmentative and Alternative Communication 181
Chapter Highlights 184
Study and Review Questions 186
Study and Review Answers 192
CHAPTER 5Speech Sound Development and Disorders 194
Foundations of Articulation and Phonology 195
Basic Definitions 196
Acquisition of Articulatory and Phonological Skills: Typical Development 197
Theories of Development 197
Infant Development: Perception and Production 199
Typical Articulation Development in Children 201
Overall Intelligibility 201
Typical Phonological Development in Children 203
Speech Sound Disorders 205
General Factors Related to Speech Sound Disorders 205
Description of Articulatory Errors 207
Organically Based Disorders 208
Contents xi
Assessment of Speech Sound Disorders 213
Screening 213
General Assessment Objectives 213
Related Assessment Objectives 213
Assessment Procedures 214
Specific Components of an Assessment 215
Scoring and Analysis of Assessment Data 217
Treatment of Speech Sound Disorders 220
General Considerations in Treatment 220
Motor- Based Approaches 222
Linguistic Approaches 224
Core Vocabulary (Consistency) Approach 226
Phonological Awareness Treatment 227
Chapter Highlights 229
Study and Review Questions 230
Study and Review Answers 234
CHAPTER 6Fluency and Its Disorders 236
Fluency and Stuttering: An Overview 237
Definition and Description of Fluency 237
Definition and Description of Stuttering 238
Forms of Dysfluencies 239
Theoretical and Clinical Significance of Dysfluencies 240
Incidence and Prevalence of Stuttering 241
Onset and Development of Stuttering 245
Associated Motor Behaviors 246
Associated Breathing Abnormalities 246
Negative Emotions and Avoidance Behaviors 247
The Loci of Stuttering 247
Stimulus Control in Stuttering 248
People Who Stutter and Their Families 249
Theories of Stuttering 250
Assessment and Treatment of Stuttering 252
Assessment of Stuttering 252
Treatment of Stuttering 254
Neurogenic Stuttering 261
Definition and Etiology of Neurogenic Stuttering 261
xii Contents
Description of Neurogenic Stuttering 262
Assessment and Treatment of Neurogenic Stuttering 262
Cluttering 263
Definition and Description of Cluttering 263
Assessment and Treatment of Cluttering 264
Other Types of Fluency Disorders 265
Chapter Highlights 265
Study and Review Questions 266
Study and Review Answers 270
CHAPTER 7Voice and Its Disorders 272
Vocal Anatomy and Physiology 273
The Larynx 273
Voice Changes Through the Life Span 280
Vocal Pitch, Loudness, and Quality 282
Pitch 282
Loudness 283
Quality 283
Evaluation of Voice Disorders 285
Case History: Purposes and Goals 285
A Team- Oriented Approach 286
Instrumental Evaluation 286
Perceptual Evaluation 291
Quality of Life Evaluation 293
Disorders of Resonance and Their Treatment 294
Hypernasality 295
Hyponasality 296
Assimilative Nasality 296
Cul-de-Sac Resonance 296
Treatment Principles 297
Disorders of Phonation and Their Treatment 298
Carcinoma and Laryngectomy 299
Voice Disorders 303
Physically Based Disorders of Phonation 304
Idiopathic Voice Disorders 317
Neurologically Based Voice Disorders 317
Contents xiii
Psychogenic Voice Disorders 321
Behavioral Voice Therapy 322
Gender Issues and the Voice 327
Chapter Highlights 329
Study and Review Questions 330
Study and Review Answers 335
CHAPTER 8Neurologically Based Communicative Disorders 336
Aphasia 337
Incidence and Prevalence of Aphasia 337
Neuropathology of Aphasia 338
Key Terms 339
Definition and Classification of Aphasia 340
Nonfluent Aphasias 340
Fluent Aphasias 344
Subcortical Aphasia 348
Crossed Aphasia 348
Aphasia in Bilingual Populations 348
Assessment of Aphasia 349
Treatment of Aphasia 354
Alexia and Agraphia 359
Agnosia 360
Dementia 360
Definition and Classification of Dementia 361
Dementia of the Alzheimer Type 361
Frontotemporal Dementia 363
Dementia Associated With Parkinson’s Disease 366
Dementia Associated With Huntington’s Disease 367
Infectious Dementia 368
Other Forms of Dementia 371
Assessment of Dementia 372
Clinical Management of Dementia 373
Right Hemisphere Disorder 375
The Right and the Left Hemispheres 375
Symptoms of Right Hemisphere Disorder 375
Assessment of Right Hemisphere Disorder 377
Treatment of Right Hemisphere Disorder 378
xiv Contents
Traumatic Brain Injury 379
Definition and Incidence of TBI 379
Common Causes of TBI 380
Types and Consequences of TBI 380
General Assessment of Persons With TBI 382
Assessment of Communicative Deficits Associated With TBI 383
Treatment of Persons With TBI 384
Chapter Highlights 386
Study and Review Questions 387
Study and Review Answers 390
CHAPTER 9Motor Speech Disorders and Dysphagia 392
Apraxia of Speech 393
Definition and Distinctions 393
Neuropathology of AOS 394
General Symptoms of AOS 395
Communication Deficits in AOS 395
Assessment of AOS 396
Treatment of AOS 397
The Dysarthrias 398
Definition of the Dysarthrias 398
Neuropathology of the Dysarthrias 403
Communicative Disorders Associated With Dysarthria 403
Types of Dysarthria 404
Differentiating Apraxia of Speech From Dysarthria 412
Assessment of the Dysarthrias 412
Treatment of the Dysarthrias 414
Swallowing Disorders 416
The Nature and Etiology of Swallowing Disorders 416
Normal and Disordered Swallow 417
Assessment of Swallowing Disorders 419
Treatment of Swallowing Disorders 420
Chapter Highlights 424
Study and Review Questions 425
Study and Review Answers 428
Contents xv
CHAPTER 10Cleft Palate, Craniofacial Anomalies, and Genetic Syndromes 430
Craniofacial Anomalies and Cleft Palate 431
Craniofacial Anomalies 431
Cleft Lip 431
Cleft Palate 432
Genetic Syndromes 444
Genetic Syndromes Associated With Communication Disorders 444
Chapter Highlights 453
Study and Review Questions 453
Study and Review Answers 458
CHAPTER 11Communication Disorders in Multicultural Populations 460
Foundational Issues 461
General Cultural Considerations 462
ASHA Guidelines Regarding Multicultural Issues 463
Speech– Language Characteristics of CLD Clients 464
Dialects of American English 464
African American English 465
Characteristics of AAE Morphology, Syntax, and Articulation 466
Spanish- Influenced English 468
English Influenced by Asian Languages 471
Language Differences and Language Impairment 476
Differentiating Language Differences From Language Impairments 476
Acquiring a Second Language 477
Basic Interpersonal Communication Skills and Cognitive– Academic Language Proficiency 479
Assessment of EL Students 481
Legal Considerations 482
Considerations in the Use of Standardized Tests 482
Alternatives to Standardized Tests 485
Working With Interpreters in the Assessment Process 487
Treatment Considerations in Service Delivery to CLD Clients 488
Children With Language Impairments 489
Serving CLD Adults: Prevalence and Incidence Rates of Medical Conditions and
Communication Disorders 490
xvi Contents
Potential Sociocultural and Linguistic Barriers to Service Delivery 491
Adults With Neurologically Based Disorders of Communication 492
Chapter Highlights 495
Study and Review Questions 497
Study and Review Answers 503
CHAPTER 12Audiology and Hearing Disorders 506
Anatomy and Physiology of Hearing 508
The Outer Ear 508
The Middle Ear 508
The Inner Ear 511
The Auditory Nervous System 513
Acoustics: Sound and Its Perception 515
The Source of Sound 515
Sound Waves 516
Frequency and Intensity 517
Sound Pressure Level and Hearing Level 518
The Nature and Etiology of Hearing Loss 519
Normal Hearing 519
The Nature of Hearing Impairment 520
Conductive Hearing Loss 520
Sensorineural Hearing Loss 525
Mixed Hearing Loss 528
Auditory Nervous System Impairments 528
Assessment of Hearing Impairment 531
Audiometry: Basic Principles 531
Pure-Tone Audiometry 532
Speech Audiometry 533
Acoustic Immittance 533
Other Methods 534
Hearing Screening 534
Assessment of Infants and Children 535
Interpretation of Hearing Test Results 535
Management of Hearing Impairment 539
Communication Disorders of People With Hearing Impairment 539
Aural Rehabilitation: Basic Principles 541
Amplification 542
Contents xvii
Communication Learning 547
Chapter Highlights 553
Study and Review Questions 554
Study and Review Answers 558
CHAPTER 13Assessment and Treatment: Principles of Evidence- Based Practice 560
Evidence- Based Practice in Speech– Language Pathology 561
Standard Assessment Procedures 562
Screening 562
Case History 563
Hearing Screening 565
Orofacial Examination 565
Interview 565
Speech and Language Sample 566
Obtaining Related Assessment Data 567
Principles of Standardized Assessment 568
The Nature and Advantages of Standardized Assessment 568
Limitations of Standardized Tests 569
Prudent Use of Standardized Tests 570
Types of Scores in Standardized Assessment 571
Validity and Reliability of Standardized Tests 572
Rating Scales, Questionnaires, and Developmental Inventories 573
Rating Scales 573
Questionnaires and Interviews 573
Developmental Inventories 573
Alternative Assessment Approaches 574
Functional Assessment 574
Client- Specific Assessment 575
Criterion- Referenced Assessment 576
Authentic Assessment 576
Dynamic Assessment 577
Comprehensive and Integrated Assessment 577
Treatment of Communication Disorders: Basic Concepts 578
Treatment: Definition 578
A Treatment Paradigm for Communication Disorders 579
Basic Treatment Terms 579
Reinforcers and Reinforcement 583
xviii Contents
An Overview of the Treatment Process 585
Selection of Treatment Targets 585
Treatment Sequence 586
Maintenance Program 587
Follow-Up 588
Booster Treatment 588
A General Outline of a Treatment Program 588
Seven Steps of All Treatment Programs 589
Cultural– Linguistic Considerations in Assessment and Treatment 589
The Need for Individualized Assessment and Treatment 590
Chapter Highlights 591
Study and Review Questions 592
Study and Review Answers 595
CHAPTER 14Research Design and Statistics: A Foundation for Clinical Science 596
Essentials of the Scientific Method 597
The Philosophy of Science: Basic Concepts 597
Validity of Measurements 599
Reliability of Measurements 600
Experimental Research 601
Definitions of Terms 601
Group Designs of Research 602
Single- Subject Designs of Research 604
Varieties of Descriptive Research 608
Basic Concepts 608
Ex Post Facto (Retrospective) Research 609
Survey Research 610
Comparative Research 610
Developmental (Normative) Research 610
Correlational Research 611
Ethnographic Research 612
Evaluation of Research 612
Internal Validity 613
External Validity 615
Levels of Evidence for Evidence- Based Practice 616
Data Organization and Analysis: Principles of Statistics 618
Contents xix
Basic Concepts 618
Statistical Techniques for Organizing Data 619
Types of Measurement Scales 620
Chapter Highlights 621
Study and Review Questions 623
Study and Review Answers 628
CHAPTER 15Professional Issues 630
ASHA and the Professions 631
The American Speech- Language- Hearing Association 632
The Professions of Speech– Language Pathology and Audiology 635
The Scope of Practice: Speech– Language Pathology 635
ASHA Accreditation 636
Issues in Certification and Licensure 637
Clinical Certification 637
Speech– Language Pathology Assistants 640
State Regulation of the Profession 641
Legislative Regulation of the Profession 643
Federal Legislation Affecting School Settings 643
Federal Legislation Affecting Employment Settings 645
Federal Legislation Affecting Health Care Settings 646
Future Trends 648
Chapter Highlights 649
Study and Review Questions 650
Study and Review Answers 653
Appendix 654
Study and Test- Taking Tips for the Praxis 655
The Nature and Purpose of the Praxis 655
Study Tips for Preparing for the Praxis 658
General Tips for Taking the Praxis 659
Understanding Computer- Generated Questions 662
Conclusion 663
Index 664About the Authors 694